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Diabetes Care
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Diabetes Care
Article . 2016 . Peer-reviewed
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Dynamic Changes in Renal Function Are Associated With Major Cardiovascular Events in Patients With Type 2 Diabetes

Authors: Ragot, Stéphanie; Saulnier, Pierre-Jean; Velho, Gilberto; Gand, Elise; de Hauteclocque, Astrid; Slaoui, Yousri; Potier, Louis; +8 Authors

Dynamic Changes in Renal Function Are Associated With Major Cardiovascular Events in Patients With Type 2 Diabetes

Abstract

OBJECTIVE The pattern of renal function decline prior to cardiovascular (CV) events in type 2 diabetes is not well known. Our aim was to describe the association between renal function trajectories and the occurrence of a CV event. RESEARCH DESIGN AND METHODS We considered patients with type 2 diabetes from the SURDIAGENE (Survie, Diabete de type 2 et Genetique) study (discovery cohort) and the DIABHYCAR (Non-Insulin-Dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril) study (replication cohort). Global patterns of estimated glomerular filtration rate (eGFR) (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and serum creatinine (SCr) prior to a major CV event (MACE) or last update were determined using a linear mixed-effects model and annual individual slopes computed by simple linear regression. RESULTS In the 1,040 participants of the discovery cohort, establishment of global patterns including 22,227 SCr over 6.3 years of follow-up showed an annual eGFR decline and an annual SCr increase that were significantly greater in patients with MACE compared with patients without (−3.0 and −1.7 mL/min/1.73 m2/year and +10.7 and +4.0 μmol/L/year, respectively; P < 0.0001 for both). Median annual individual slopes were also significantly steeper in patients with MACE, and adjusted risk of MACE was 4.11 times higher (3.09–5.45) in patients with rapid decline in eGFR (change less than −5 mL/min/1.73 m2/year). Consideration of renal function trajectories provided significant additive information helping to explain the occurrence of MACE for both SCr and eGFR (PIDI < 0.0001 and P = 0.0005, respectively). These results were confirmed in the replication cohort. CONCLUSIONS Renal function decline was associated with a higher risk of MACE. The pattern of renal function decline, beyond baseline kidney function, is an independent factor of CV risk.

Keywords

Male, MESH: Hypertension / complications, Type 2 / complications*, MESH: Biomarkers / blood, Chronic / complications*, [SDV]Life Sciences [q-bio], Kidney Function Tests, MESH: Linear Models, MESH: Risk Factors, [MATH.MATH-ST]Mathematics [math]/Statistics [math.ST], MESH: Glomerular Filtration Rate / physiology, MESH: Cardiovascular Diseases / complications*, 80 and over, MESH: Renal Insufficiency, [MATH.MATH-ST] Mathematics [math]/Statistics [math.ST], MESH: Aged, Aged, 80 and over, MESH: Middle Aged, MESH: Albuminuria / complications, MESH: Creatinine / blood, Middle Aged, MESH: Predictive Value of Tests, [SDV] Life Sciences [q-bio], Proteinuria, MESH: Proteinuria / complications, Cardiovascular Diseases, Creatinine, Hypertension, Female, France, Glomerular Filtration Rate, MESH: Diabetes Mellitus, Chronic / blood, 610, Predictive Value of Tests, Albuminuria, Humans, Renal Insufficiency, Chronic, Aged, Glycated Hemoglobin, MESH: Humans, MESH: Glycated Hemoglobin / analysis, MESH: Cardiovascular Diseases / blood, MESH: Male, MESH: France, Diabetes Mellitus, Type 2, Linear Models, MESH: Kidney Function Tests / methods, Type 2 / blood, MESH: Female, Biomarkers

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
40
Top 10%
Top 10%
Top 10%
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bronze